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Saturday, March 12, 2016

BACKGROUND

Improving
symptoms is a major goal of cancer medicine; however, symptom response
is often based on group differences and not individualized. In the
current study, the authors examined the personalized symptom goal (PSG)
for 10 common symptoms in patients with advanced cancer, and identified
the factors associated with PSG response.

METHODS

In
this prospective, longitudinal, multicenter study, patients from 5
tertiary care hospitals rated the intensity of 10 symptoms using a
numeric rating scale of 0 to 10 at the time of their first clinic visit
and then at a second visit 14 to 34 days later. The PSG was determined
for each symptom by asking patients: “At what level would you feel
comfortable with this symptom?” using the same scale of 0 to 10 for
symptom intensity. PSG response was defined as symptom intensity at the
time of the second visit that was less than or equal to the PSG.

RESULTS

Among
728 patients, the median PSG was 1 for nausea; 2 for depression,
anxiety, drowsiness, well-being, dyspnea, and sleep; and 3 for pain,
fatigue, and appetite. A greater percentage of patients achieved a PSG
response at their second visit compared with their first visit (P<.05
except for drowsiness). Symptom response was associated with lower
baseline symptom intensity based on PSG criterion but higher baseline
symptom intensity based on the traditional minimal clinically important
difference definition (P<.001 for all symptoms). In multivariable analysis, higher PSG and nationality were associated with greater PSG response.

CONCLUSIONS

The
PSG was ≤3 for a majority of patients. PSG response allows clinicians
to tailor treatment goals while adjusting for individual differences in
scale interpretation and factors associated with symptom response.